Voices for Change

... Reasonable people are left to ask: how can a scientifically-proven treatment that reduces mortality in a definable population be such an afterthought in our health care system? There is truly no good answer. Indeed, this is an unacceptable and indefensible outcome in an area that affects hundreds of thousands of Americans… Medicine cannot be a backwater where historic inequities in care are much discussed, where the statistics of lives cut short are duly recorded, but not a finger is lifted to address systemic problems. Black lives matter in our streets, in our hospitals, in our clinics, and in our physician's offices. Indeed, every American life matters, and deserves equal access to the treatment and care that science determines to be in their best interest.”​ ​- Gary Puckrein, PhD, President, National Minority Quality Forum

At the Association of Black Cardiologists (ABC), there is no issue more central to our cause than ensuring that all Americans are given the foremost care to combat, treat, and overcome cardiovascular disease. This includes the recognition that cardiovascular disease occurs disproportionately in African Americans. The National Minority Quality Forum’s (NMQF’s) recently proposed quality measure represents a critical step towards furthering these goals, and we hope that you will join us in encouraging its widespread adoption by providers across the country.”

I am a cardiologist in clinical practice with a large number of African American patients. I see the daily struggles of patients whose quality of life is deeply impacted. […] The most recent analysis of America's superior hospitals, show that very few African American patients are receiving this therapy. I join with others concerned with health disparities and the attainment of health equity, in asking NQF to add FDC I/H as a standard of care for self-described African Americans, as contained in every heart failure guideline since 2004.”

The National Alliance for Hispanic Health (the Alliance) is deeply concerned that too many of the quality measures being promulgated by the National Quality Forum do not reflect the need to tailor treatment protocols to individual patient populations and the science of precision medicine… Adopting this measure of care is long overdue.”

​ ​- Adolph Falcon, Senior Vice President at the National Alliance for Hispanic Health

When considering the number of lives that can potentially be saved annually -- over the past decade, approximately 66,550 African Americans have perished without being provided the opportunity to choose Hydralazine and Isosorbide Dinitrate Therapy. It is alarming that only ‘10% of eligible heart failure patients are being prescribed this FDA-approved treatment,’ which ‘has been proven to reduce mortality in blacks by 43% and first-time hospitalizations for HF by 38%.’ That's why I'm writing in support of the measure submitted by the National Minority Quality Forum (NMQF) that strongly encourages healthcare providers to ensure that eligible African American patients with heart disease receive the proper course of treatment.”

​ ​- Ilen Bell, Co-Founder of Black Fitness Today

The American Kidney Fund (AKF) offers its full support of NQF# 2764. AKF is dedicated to ensuring that every kidney patient has access to health care, and that every person at risk for kidney disease is empowered to prevent it. […] We believe that adoption of this quality measure will improve African Americans’ access to this life-saving treatment and will not only directly improve the outcomes for HF, but also indirectly improve the outcomes for African Americans at-risk for CKD.”

​ ​- LaVarne Burton, President and CEO of the American Kidney Fund

HLC members advocate measures to increase the quality and efficiency of American healthcare by emphasizing wellness and prevention, care coordination, and the use of evidence-based medicine, while utilizing consumer choice and competition to elevate value… We believe there is tremendous potential for the health care industry as a whole to bring about robust collaboration and quality improvement in achieving our shared goal of improving the value of healthcare delivery for all.”

​ ​- Chris Adamec, MPA, Director of Policy at the Healthcare Leadership Council

As a clinician and clinical trialist, I am amazed at the gap between trial results and real-world prescription of a life-saving therapy for patients with HF such as we see with the under-use of hydralazine/nitrates in Blacks/African Americans. I agree this is a hugely important topic in need of further scrutiny and comment.”

The National Minority Quality Forum’s measure will incentivize healthcare providers to ensure that eligible African American patients with chronic heart failure receive the highest standard of care as the benefits of the fixed-dose combination have been published in the New England Journal of Medicine and other peer-reviewed sources… Most importantly however, it will create equity in health care quality and outcomes, quality measures that recognize and value the full diversity of heart failure patients. ​- Thomas Joseph Berger, Ph.D., Vietnam Veterans of America Veterans Health Council

Despite the treatment’s demonstrated efficacy, and guidelines recommending its use as the standard of care, alarmingly few African American patients are being prescribed this FDA-approved treatment. CMS claims data indicates that 90% of the eligible black patients meeting the indication do not receive this therapy. Acknowledging that this is a new eMeasure with overall performance data currently unavailable, I believe the Committee’s approval represents an indispensable opportunity to fully capture the extent of the disparity created when eligible African American patients do not receive this life-saving treatment. ​- Beverly E. Oliver, FNP-BC, St. Dominic-Jackson Memorial Hospital

Our current trainees are learning little about this treatment opportunity in their current curricula. As a professor, it is most alarming that other teachers and attending professionals do not know how to adequately prescribe or dose the medicines appropriately and that there IS NO GENERIC EQIVALENT. So, the perpetuation of this type of neglect has vast repercussions and dreadful predictions for the future that [an] immediate address[ing] of this problem [would] promise immense future returns.

​ ​- David Smith, Clinical Assistant Professor at Yale University

WellCare Health Plans, Inc. fully supports the endorsement of NQF quality measure #2764, ‘Fixed-dose Combination of Hydralazine and Isosorbide Dinitrate Therapy for Self-identified Black or African American Patients with Heart Failure and LVEF <40% on ACEI or ARB and Beta-blocker Therapy.’ […] As one of the country’s largest health care companies dedicated solely to serving public program beneficiaries, we see the effects that disparities can have on health outcomes. Adoption of this measure will ensure that eligible African American patients with symptomatic heart failure receive the proposed course of treatment.”

​ ​- Kiersten Adams, Public Policy at WellCare Health Plan

I am a cardiologist in an urban academic setting and I am writing to express my support for the NQF Cardiovascular Standing Committee recommendation in its Cardiovascular 2015-2016 Draft Report to approve eMeasure #2764 for trial use… I agree with the Committee’s findings that the measure warrants Approval for Trial Use because of its importance, use and usability, and feasibility, with additional lead time for reliability and validity testing results that will support full NQF endorsement.” ​- Bryan Curry, Howard University

​The Committee’s draft report correctly notes that the only data relied on by the above guidelines were from studies using a fixed-dose combination. According to the FDA, neither of the component compounds are approved for this fixed-dose therapy, as neither has an indication for HF in their label. I applaud the Committee for appropriately limiting the measure to capture this specific treatment, as a similar measure already exists that does not require a fixed-dose combination.” ​- Wallace Robert Johnson, Jr., MD, University of Maryland

Although, heart failure affects millions of Americans, African American are disproportionately affected by heart failure with age-adjusted death rates remaining higher in African Americans than other populations. And despite the fact that there is an FDA-approved treatment that has been proven to be particularly effective in African Americans, only a small percentage of those who are clinically eligible are receiving the treatment.”

​ ​- Oladipupo Olafiranye, Assistant Professor of Medicine at the University of Pittsburgh

Health care disparities continue to exist in minority populations for many reasons including clinical access, formulary availability, mistrust, socioeconomic position, and cultural and language issues just to mention a few. […] By making isosorbide dinitrate/hydralaziine a quality improvement measure in blacks who meet the definition of the AHEFT clinical trial we will ensure that this minority population who face tremendous obstacles from the social determinants of health to at least be assured of getting the best evidence base for clinical care.”

​ ​- Jay Neil Basile M.D., Professor of Medicine at the Medical University of South Carolina